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Slit lamp assessment of a diagnostic scleral lens applied to an eye with keratoconus. Estimation of apical (A), mid-peripheral (B), and limbal vault (C) with sodium fluorescein filled fluid reservoir. Note the asymmetry in the fluid reservoir thickness in (A), common in keratoconus. Estimation of apical (D), midperipheral (E), and limbal vault (F) without sodium fluorescein. Landing zone assessment under low (G) and high magnification (H). Assessing the mid-peripheral and limbal vault is challenging since the lens thickness in that area is different than center lens thickness. Image credit Maria Walker.
Source publication
Scleral lenses were the first type of contact lens, developed in the late nineteenth century to restore vision and protect the ocular surface. With the advent of rigid corneal lenses in the middle of the twentieth century and soft lenses in the 1970’s, the use of scleral lenses diminished; in recent times there has been a resurgence in their use dr...
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Purpose
To evaluate the reproducibility, and therefore the utility, of using traditional tonometry devices for measuring intraocular pressure (IOP), while a prosthetic replacement of the ocular surface ecosystem device (PD) or scleral lens is applied to the eye.
Patients and Methods
Twenty subjects (40 eyes) with keratoconus were enrolled. With PD...
Objective:
Keratoconus is a corneal ectasia that leads to thinning and steepening of the corneal surface. We aimed to assess the relationship between quality of life and corneal tomography indices, irrespective of visual acuity.
Methods:
This was a cross-sectional study using a translated and validated Keratoconus Outcomes Research Questionnaire...
Aims: This study aims to reveal misconceptions about keratoconus, to assess the level of knowledge among Saudi nationals and to compare the level of awareness of keratoconus between affected and unaffected individuals. Methodology: A cross-sectional study was conducted through an online survey on a study population that consisted of Saudi nationals...
Objectives:
The aim of this study was to evaluate the ocular surface alterations of conjunctival cytological changes and tear function in patients with keratoconus.
Methods:
A total of 98 eyes with keratoconus and 68 eyes of age- and sex- matched healthy subjects were included in this prospective study. Ophthalmological evaluations, including Oc...
Background: Over recent years a revolutionary trend happened on imaging technologies to diagnose and monitor treatment of a varied group of ophthalmic pathologies. Recent reports have analyzed the microstructural changes of the various ocular surface and corneal disorders, particularly ocular surface squamous neoplasia (OSSN) and keratoconus using...
Citations
... However, complications related to scleral lens wear include infection, insertion and removal obstacles, and anomalies like conjunctival prolapse and epithelial swelling. These also include rare hypoxic and inflammatory complications [102][103][104][105]. Novel surgical procedures also include transposition or transplantation of the salivary glands, amniotic membrane transplanta-tion, and stem cell-based injections into the lacrimal gland [106]. ...
Dry eye disease (DED) is a continuing medical challenge, further worsened in the autoimmune inflammatory hyperactivation milieu of Sjögren’s syndrome (SS) due to disturbances to innate and adaptive immunity with malfunctioning neuro-endocrine control. However, the pathogenetic mechanisms of SS DED are not fully established. This review summarized the available evidence, from systematic reviews, meta-analyses, and randomized clinical trials, for the efficacy and safety of the available ocular therapeutics for the management of SS DED. Relevant studies were obtained from major databases using appropriate keywords. The available largely empirical symptomatic, supportive, and restorative treatments have significant limitations as they do not alter local and systemic disease progression. Topical therapies have expanded to include biologics, surgical approaches, scleral lens fitting, the management of lid margin disease, systemic treatments, nutritional support, and the transplantation of stem cells. They are not curative, as they cannot permanently restore the ocular surface’s homeostasis. These approaches are efficacious in the short term in most studies, with more significant variability in outcome measures among studies in the long term. This review offers an interdisciplinary perspective that enriches our understanding of SS DED. This updated review addresses current knowledge gaps and identifies promising areas for future research to overcome this medical challenge.
... After plasma treatment, improvement in wettability is also associated to conversion of silicone into hydrophilic silicate [85,86]. However, the plasma treatments and wetting agent have no permanent effects [87] with also sometimes negligible benefits in comfort [88,89]. ...
Contact Lens Discomfort (CLD) is the main cause in contact lens (CLs) discontinuation, referred in literature as drop-out phenomenon. Despite such evidence was reported in several clinical studies, a relationship between physico-chemical properties of CLs and CLD is not still totally understood. In this regard, the friction of CLs surfaces seems to be related to discomfort feeling events, probably due to an alteration of the lubricate function of the tear film after the CL placement inside the ocular environment. In the last years, many studies have been finalized to the friction measurements of CLs surface, finding conflicting data due to a lack in standardized protocol. The aim of this review is primarily to show evident relationships between CLs surface properties (i.e. wettability, tear evaporation, tear film quality, etc.) and the coefficient of friction (CoF), resulting therefore the most relevant physical quantity in the CLs characterization. In addition, we reported the most recent studies in CLs tribology, which highlight that the introduction of a standard protocol in CoF measurements is necessary to obtain reproducible results, considering the aim to evaluate in a more precise way the relationship between this material surface property and comfort in CLs users.
... The therapeutic benefits of SLs have been reported for patients with severe dry eye including Stevens-Johnson syndrome, graft-versus-host disease, and Sjogren syndrome. [19][20][21][22] Management of dry eye has associated time and economic burdens for patients. To better access the unfiltered experiences of patients who have dry eye and also wear therapeutic contact lenses, an online survey was administered to individuals who accessed educational materials, online support services, or social media forums dedicated to patients with various forms of dry eye disease. ...
... All respondents were asked to estimate the amount of time spent daily on management of their dry eye condition (none, 5,10,15,20,25,30,35,40,45, 50 min, 1, 1.5, 2, 2.5, or 3 hrs or more). ...
Objectives
To report patient-reported experiences with dry eye disease and therapeutic contact lenses.
Methods
A survey was distributed to patients with dry eye disease. Demographics, Ocular Surface Disease Index (OSDI), systemic disease, contact lens history, and burden of care information were collected. Descriptive statistics are presented and categorized by nonlens, soft lens, and scleral lens (SL) wearers.
Results
Of 639 respondents, 15% (94/639) were currently using therapeutic soft or SLs (47 soft and 69 SL). Mid-day fogging or clouding of vision was reported by SL (75%, 50/67) and soft lens (62%, 29/47) wearers. Seventy-two percent of SL wearers spent more than 20 min daily on dry eye treatment while 43% of soft lens wearers spent more than 20 min. Median annual expenditure was higher for SL ($1,500, n=63) than nonlens ($500, n=371) or soft lens wearers ($700, n=43). Mean OSDI scores in all groups were in the severe category (51±22 years, n=401 nonlens wearers; mean age; 45±22 years, n=47 soft lens wearers; 60±24 years, n=69 SL wearers).
Conclusions
Mid-day fogging and blurring of vision was reported by most of the individuals using therapeutic lenses for dry eye disease. SL wearers allocate the most resources for dry eye care.
... In order to improve the surface wetting of rigid lenses, as well as patient comfort and vision, plasma ionization technology can make contact lens surfaces form ultraclean hydrophilic rigid surfaces. 42 On this basis, the application of polyethylene glycol polymer coating can significantly increase the wettability of the lens surface and reduce the deposition of protein and fat. With the advancement of manufacturing technology and ophthalmic imaging, more and more companies have entered the established SCCL market and the research in this field is very active. ...
... According to statistics, the most common clinical indications for advanced SCCLs are primary corneal ectasia (53%), ocular surface disease (18%), and penetrating keratoplasty (17%). 42 In terms of refraction, SCCLs are mainly used to solve corneal irregularities, high refractive errors, high corneal astigmatism, or patients who are not satisfied with wearing other contact lenses. 44 SCCLs can help to reduce higher-order aberrations in irregular corneas from different causes, including keratoconus, penetrating keratoplasty, and after refractive surgery. ...
Unlike conventional glasses, corneal contact lenses (CLs) can directly contact the surface of the tear film through the application of biopolymer materials, to achieve therapeutic and cosmetic purposes. Since the advent of polymethylmethacrylate, a material that has gained widespread use and attention, statistically, there are now more than 150 × 106 people around the world who wear corneal contact lenses. However, the associated complications caused by the interaction of contact lenses with the ocular surface, tear film, endogenous and environmental microorganisms, and components of the solution affect nearly one-third of the wearer population. The application of corneal contact lenses in correcting vision and myopia control has been widely recognized. With the development of related materials, corneal contact lenses are applied to the treatment of ocular surface diseases, including corneal bandage lenses, drug-loaded corneal contact lenses, biosensors, and other new products, while minimizing the side effects associated with CL wear. This paper summarized the development history and material properties of CLs, focused on the current main clinical applications and mechanisms, as well as clarified the possible complications in wearing therapeutic contact lenses and the direction for improvement in the future.
... 16,17 Recent studies have reported the use of large-diameter, rigid, gaspermeable contact lenses (CLs) for the improvement of visual acuity (VA) and the prevention of ocular surface deterioration in the chronic phase of diseases such as SJS/TEN. [18][19][20][21][22][23][24][25][26][27][28][29][30] The SUNCON Kyoto-CS (Sun Contact Lens Co, Ltd, Kyoto, Japan) limbal-rigid CL was developed for the purpose of vision correction and tear retention in the chronic phase of SJS/TEN. [31][32][33] Similarly, scleral CLs have been approved by the US Food and Drug Administration as a special therapy for corneal disorders, 34,35 and large-diameter rigid scleral CLs have been used for the treatment of SJS/TEN-related ocular surface disorders. ...
... There have been various reports on the management of the chronic phase of SJS/TEN, and limbal-rigid CL wear may be one of those management options in the future, as well as the use of other scleral lenses. [18][19][20][21][22][23][24][25][26][27][28][29][30] This finding indicates that VA improvement with limbal-rigid CL placement is maintained over the long term in patients with SJS/TEN in the chronic phase. This suggests that VA improvement with limbal-rigid CL wear is not temporary but sustained over the long term. ...
Objectives:
To evaluate the long-term benefits of tear-exchangeable, limbal-rigid contact lens (CL) wear therapy in patients with Stevens-Johnson syndrome (SJS)-associated ocular sequelae.
Methods:
This retrospective study evaluated 50 eyes of 41 SJS patients (15 men and 26 women) who underwent limbal-rigid CL wear therapy for more than 2 years post fitting. Ocular sequelae (i.e., conjunctival hyperemia, corneal neovascularization, and upper tarsus scarring) before fitting and at 3 months, 6 months, 12 months, and annually after initiating CL wear therapy were evaluated and then graded on a severity score (range: 0-3, maximum score: 3). Moreover, visual acuity (VA) at immediately post initiating CL wear therapy was evaluated.
Results:
The mean follow-up period was 4.3±1.1 years. Compared with before fitting, the mean conjunctival hyperemia score improved from 1.14 to 0.86 at 3 months of CL wear therapy (P<0.01) and was maintained thereafter; the mean corneal neovascularization score improved from 2.10 to 1.98 at 3 months of CL wear therapy, with no deterioration of the score observed in all cases at the final follow-up examination, and mean VA (log of minimum angle of resolution) improved from 1.60 to 1.04 at immediately post initiating CL wear therapy (P<0.01).
Conclusions:
Limbal-rigid CL wear therapy can provide long-term ocular surface stabilization and improved VA in SJS patients.
... The CLEAR report on Scleral lenses [10] lists the numerous indications for their use. The report lists primary corneal ectasia, ocular surface disease and post-penetrating keratoplasty as the three most common clinical conditions treated with contemporary scleral lenses. ...
... [9][10][11] Conflicting effects on corneal thickness were reported. Some studies found an increase of central corneal thickness directly after removal of the scleral CL. 10,11,28 Conversely, other authors found a corneal thinning with scleral CL wear. 29 It should be noted that reported changes in pachymetry after temporary scleral CL wear were small and therefore not likely to be clinically relevant. ...
Objective:
To evaluate the effect of specialty contact lens (CL) wear on posterior corneal tomography in keratoconus subjects.
Methods:
Patients with keratoconus who were wearing specialty CL were included in this retrospective cohort study. Tomographic parameters were evaluated with Scheimpflug imaging (Pentacam HR) before lens fitting and immediately after removal of CLs worn habitually for a period of several months. Subjects were divided into groups, according to type of lens (corneal, scleral, and hybrid) and keratoconus severity based on Belin/Ambrosio D (BAD-D) score, for further analysis.
Results:
Thirty-four eyes of 34 subjects diagnosed with keratoconus were included. Mean duration of habitual CL wear was 7.0±0.3 months. For the entire cohort, a small increase in flat keratometric reading at the anterior corneal surface (K1F; P=0.032) and at the posterior surface (K1B; P=0.041) was found. In the corneal CL group (10 eyes; 29.4%), flattening of the anterior corneal curvature was detected (Kmax; P=0.015). An increase in K1B value was seen in the scleral CL group (15 eyes; 44.1%) (P=0.03). Combined topometric indices showed a small but significant difference in the entire cohort (P<0.05) and in the subgroups of corneal CL wear and of moderate keratoconus (BAD-D score≥7).
Conclusion:
Various types of specialty CLs exert a differential influence on corneal parameters. A small steepening of keratometry at the posterior surface (K1B) was observed in the scleral lens group. Although corneal lens wear flattens the anterior cornea (Kmax), it does not significantly alter the posterior corneal surface.
... 20 The reservoir should initially be about 300µm to 350µm, which will reduce during the day by about 10µm to 125µm, with about half of the loss occurring in the fi rst 30 minutes of wear. 21 My experience is that physiological response is also improved if the prescriber takes care to adapt the scleral peripheries to the signifi cant irregularities of the ocular surface. Fortunately, technological advances over the past 10 years have increased the availability of instruments that measure the surface shape beyond the cornea. ...
32 NAVIGATING LENS CHOICE I t Õs diffi cult not to observe that the recent industry focus on scleral contact lenses-whether pertaining to clinical education, research and development, and/ or practice management-has defi nitely outpaced the attention paid to corneal gas permeable lenses. While we enthusiastically embrace the continuing developments in scleral lens technology, it's critical that we likewise devote educational curricula, professional resources, and industry support to ensure that corneal GP lenses remain an equally viable and valuable tool in our management of patients requiring rigid lens designs. 1 Contact lens fi tting in general involves a high level of clinical decision making and, perhaps even more when it pertains to complex refractive errors, underlying pathology, and/or irregular corneal or scleral shape. While we were invited to present a point-counterpoint, we fi nd it difficult to choose between two lens modalities , as we are deeply convinced that each one has its place in current contact lens practice. Here, we present key considerations and a clinical rationale for deciding between scleral lenses and corneal GP designs. HISTORICAL PERSPECTIVE Scleral lenses were the fi rst vision-correcting lenses in the 19th century, but for a long time they were limited by technology. They could not be manufactured in a relatively reproducible way, and their design could not be too complex, as they were made with blown-glass techniques or by hand with tools that were much less precise than the machines we have today. The primary challenge in their use was the physiological response to wearing them. With low oxygen permeability and thick lens designs, scleral lenses were often associated with signifi cant levels of hypoxia that were detrimental to the patient's condition. 2 Donald F. Ezekiel, AM, Dip Opt WA, DCLP, reintroduced the concept using modern manufacturing methods , including the use of higher oxygen permeability materials. 3,4 Over the last 10 years, technological advances in materials and designs, and a better understanding of the ocular surface, have made scleral lens designs more refi ned and indispensable. The fi rst all-plastic polymethylmethacrylate (PMMA) corneal lenses were developed in the late 1940s. They were smaller than the originally designed scleral contact lenses of the 1930s and early 1940s, which were made of glass or a glass/plastic combination. While these new smaller lenses greatly improved comfort and wearing time due to their thinner and lighter profi le, there Intel on navigating the choice between these lens modalities.
... More recently, modern scleral topographers such as the Eye Surface Profiler (Eaglet Eye, Netherlands) and the sMap3D™ corneoscleral topographer (Visionary Optics, USA) were introduced to the market [7][8][9][10], and a new corneo-scleral-profile software module for the Pentacam (Oculus, Wetzlar, Germany) was launched [7,11]. ...
Purpose
The corneo-scleral-profile (CSP) describes the transition from cornea to sclera, while the corneo-scleral junction angle (CSJ), is the angle formed between the cornea and the sclera. The aims of this study were (i) to analyse the CSP and CSJ in different quadrants and (ii) to test correlation and repeatability of an established observational grading and measurement method, using Scheimpflug images.
Methods
The nasal, temporal, superior and inferior CSP of 35 healthy eye participants (mean age 25.5 SD ± 3.1 years; 20 female) was imaged using the corneo-scleral-profile module of the Pentacam (Oculus, Wetzlar, Germany). On the captured Scheimpflug images CSP was subjectively graded into five different corneo-scleral transitions, using the Meier grading scale (profile 1 fluid-convex; profile 2 fluid-tangential; profile 3 marked-convex; profile 4 marked-tangential; profile 5 concave). The CSJ was measured on the same images using ImageJ v1.8.0. Grading and measurement was repeated at a second session. Intra-observer reliability for the CSP-grading was analysed by Cohen’s Kappa. Differences between repeated CSJ-measurements and different quadrants were analysed by paired-t-test and ANOVA. The eta-coefficient was used to determine the association between subjective CSP-grading and CSJ-measurement.
Results
Intra-observer reliability for the CSP grading system was poor (kappa = 0.098) whereas repeated measurements of CSJ angle showed no statistically significant difference between sessions (0.04°; 95 % CI − 0.21° to 0.29°; p = 0.77). CSJ angles ranged from 172° to 180° with no statistically significant differences between nasal, temporal, superior and inferior (p = 0.24). Eta-coefficient indicated a weak association between CSP-grading and CSJ-measurement (η = 0.27; p = 0.04).
Conclusions
The subjective CSP-grading showed poorer repeatability than the objective CSJ-measurement, which did not detect any differences in angles between the meridians.
The weak association between CSP-grading and CSJ-measurement is likely caused by the limited intra-observer reliability of the Meier grading scale. Furthermore, the CSP-grading scale seems to consider other aspects beside the CSJ angle, such as scleral radius.
... 1,2 Large-diameter rigid gas-permeable CLs, which are commonly referred to as "scleral lenses,", "corneoscleral lenses," and "limbal-rigid CLs," 3,4 are used for the refractive correction of corneal irregularities (e.g., keratoconus), as well as after penetrating keratoplasty or trauma, and for the management of ocular surface disorders (OSDs) such as limbal stem-cell deficiency, Sjögren syndrome, and graft-vs-host disease. [5][6][7][8][9] Reportedly, the primary purpose of prescribing large-diameter rigid gas-permeable CLs is to improve visual acuity through the correction of optical aberrations and the added benefit of helping to manage dry eye. 3,5 Scleral lenses provide several therapeutic effects for patients afflicted with OSDs, such as the masking of irregular astigmatism, the reduction of higher-order aberrations, and the establishment of a precorneal fluid reservoir for the prevention of tear evaporation and corneal dehydration. ...
... [5][6][7][8][9] Reportedly, the primary purpose of prescribing large-diameter rigid gas-permeable CLs is to improve visual acuity through the correction of optical aberrations and the added benefit of helping to manage dry eye. 3,5 Scleral lenses provide several therapeutic effects for patients afflicted with OSDs, such as the masking of irregular astigmatism, the reduction of higher-order aberrations, and the establishment of a precorneal fluid reservoir for the prevention of tear evaporation and corneal dehydration. When scleral lenses are worn in cases with severe dry eye or incomplete closure of the eyelid, the patients commonly complain of cloudy vision and lens fogging, which requires the lenses to be removed and cleaned multiple times per day. ...
Recently, the prescription of large-diameter rigid gas-permeable contact lenses (CLs), also known as "scleral lenses," "corneoscleral lenses," and "limbal-rigid CLs," is on the rise for the treatment of both moderate and severe ocular surface disorders (OSDs). Compared with scleral lenses, the diameter of limbal-rigid CLs is generally smaller, that is, a diameter ranging from 13.0 to 14.0 mm, and they are designed so that the peripheral edge bears on the limbus. The Suncon Kyoto-CS (Sun Contact Lens Co., Ltd.) is a novel limbal-rigid CL design with multistep curves on the peripheral edge for easy tear exchange during blinking that removes debris and prevents lens clouding or fogging, thus allowing patients to enjoy a longer daily duration of CL wear. In severe OSD cases, limbal-rigid CL wear after surgery is a noninvasive therapeutic approach that can neutralize corneal irregularities, decrease dry eye symptoms, prevent the progression or recurrence of symblepharon, and improve the patient's visual acuity and overall quality of life. Thus, surgeries such as amniotic membrane transplantation and cultivated oral mucosal epithelial transplantation, as well as limbal-rigid CL wear, which is noninvasive, are valuable and effective treatment strategies that can now be applied for the management of patients afflicted with severe OSDs.
